Test collections for medical information retrieval evaluation

The web has rapidly become one of the main resources for medical information for many people: patients, clinicians, medical doctors, etc. Measuring the effectiveness with which information can be retrieved from web resources for these users is crucial: it brings better information to professionals for better diagnosis, treatment, patient care; and helps patients and relatives get informed on their condition. Several existing information retrieval (IR) evaluation campaigns have been developed to assess and improve medical IR methods, for example the TREC Medical Record Track [11] and TREC Genomics Track [10]. These campaigns only target certain type of users, mainly clinicians and some medical professionals: queries are mainly centered on cohorts of records describing a specific patient cases or on biomedical reports. Evaluating search effectiveness over the many heterogeneous online medical information sources now available, which are increasingly used by a diverse range of medical professionals and, very importantly, the general public, is vital to the understanding and development of medical IR. We describe the development of two benchmarks for medical IR evaluation from the Khresmoi project. The first of these has been developed using existing medical query logs for internal research within the Khresmoi project and targets both medical professionals and general public; the second has been created in the framework of a new CLEFeHealth evaluation campaign and is designed to evaluate patient search in context

The Electronic Health Record Scorecard: A Measure of Utilization and Communication Skills

As the adoption rate of electronic health records (EHRs) in the United States continues to grow, both providers and patients will need to adapt to the reality of a third actor being present during the visit encounter. The purpose of this project is to provide insight on “best” practice patterns for effective communication and efficient use of the EHR in the clinical practice setting. Through the development of a comprehensive scorecard, this project assessed current status of EHR use and communication skills among health care providers in various clinical practice settings. Anticipated benefits of this project are increased comfortability in interfacing with the EHR and increased satisfaction on the part of the provider as well as the patient. Serving as a benchmark, this assessment has the potential to help guide future health information technology development, training, and education for both students and health care providers

Annotated Bibliography: Understanding Ambulatory Care Practices in the Context of Patient Safety and Quality Improvement.

The ambulatory care setting is an increasingly important component of the patient safety conversation. Inpatient safety is the primary focus of the vast majority of safety research and interventions, but the ambulatory setting is actually where most medical care is administered. Recent attention has shifted toward examining ambulatory care in order to implement better health care quality and safety practices. This annotated bibliography was created to analyze and augment the current literature on ambulatory care practices with regard to patient safety and quality improvement. By providing a thorough examination of current practices, potential improvement strategies in ambulatory care health care settings can be suggested. A better understanding of the myriad factors that influence delivery of patient care will catalyze future health care system development and implementation in the ambulatory setting

Engaging persons with mental illness and/or substance use disorder in care coordination services: an improvement project at a federally qualified community health center

Background: Mental health and substance use disorders seldom occur in isolation. They frequently accompany each other, as well as a substantial number of chronic general medical illnesses. Consequently, mental health conditions, substance-use disorders, and general health conditions are frequently co-occurring, and coordination of all of these types of health care is essential to improved health outcomes (Institute of Medicine, 2006). The U.S. system of healthcare is failing to identify, engage, and effectively treat people who are suffering from behavioral health conditions (Blanco, Coye, Knickman, Krishnan, Krystal, Pincus, Rauch, Simon, Vitiello, 2016). Because of poor coordination and lack of engagement, people often experience disrupted care and an over-reliance on emergency department and hospital care. At Lowell Community Health Center where this project takes place persons with a primary behavioral health diagnosis contribute to the highest utilization of emergency and inpatient hospital services. In July of 2018, Lowell CHC collaborated with Lowell House, Inc. to form a care coordination program to outreach and engage individuals identified as high utilizers of inpatient and emergency hospital services. Aim: The aim of this project is to describe the attributes of the population of patients who successfully engaged into care for the first six months of this new program, with recommendations for improvement to inform future program design. Method: The population of patients who successfully engaged in care in the first 6 months of the program described by independent variables consisting of age, gender, race, and preferred language. Dependent variable consisting of type of outreach. Data was evaluated to determine attributes of patients who successfully engaged in care and if correlations exist between variables and successful engagement. Results: The first six months of the program implementation demonstrated successful engagement and activation of 17.5% of patients. The average patient is described as low-income, 50-64 years of age, non-English speaking female with dual-diagnosis residing in the greater Lowell area. Themes regarding successful outreach type included telephonic and face-to-face being the most successful method of engagement. Although successful engagement was noted, longer-term efforts and analysis should focus on successful outreach and engagement strategies, emergency room utilization, treatment adherence and service adherence. Conclusions: The findings of this project indicate that having a team-based, multidisciplinary and multi-cultural approach to care coordination has led to successful engagement of 186 individuals within the first 6 months of this new program

The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente.

BackgroundPatient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited.MethodsThis paper uses qualitative methods to advance our understanding of the organizational dynamics that influence the impact of a patient portal on organizational performance and patient health. The study setting is Kaiser Permanente, the world's largest not-for-profit integrated delivery system, which has been using a portal for over ten years. We interviewed eighteen physician leaders and executives particularly knowledgeable about the portal to learn about how they believe the patient portal works and what organizational factors affect its workings. Our analytical framework centered on two research questions. (1) How does the patient portal impact care delivery to produce the documented effects?; and (2) What are the important organizational factors that influence the patient portal's development?ResultsWe identify five ways in which the patient portal may impact care delivery to produce reported effects. First, the portal's ability to ease access to services improves some patients' satisfaction as well as changes the way patients seek care. Second, the transparency and activation of information enable some patients to better manage their care. Third, care management may also be improved through augmented patient-physician interaction. This augmented interaction may also increase the 'stickiness' of some patients to their providers. Forth, a similar effect may be triggered by a closer connection between Kaiser Permanente and patients, which may reduce the likelihood that patients will switch health plans. Finally, the portal may induce efficiencies in physician workflow and administrative tasks, stimulating certain operational savings and deeper involvement of patients in medical decisions. Moreover, our analysis illuminated seven organizational factors of particular importance to the portal's development--and thereby ability to impact care delivery: alignment with financial incentives, synergy with existing IT infrastructure and operations, physician-led governance, inclusive decision making and knowledge sharing, regional flexibility to implementation, continuous innovation, and emphasis on patient-centered design.ConclusionsThese findings show how organizational dynamics enable the patient portal to affect care delivery by summoning organization-wide support for and use of a portal that meets patient needs

Building Medical Homes: Lessons From Eight States With Emerging Programs

Profiles states' progress in developing and implementing medical home programs, strategies to encourage primary care providers' adoption, and states' ability to convene stakeholders, help improve and evaluate performance, and address antitrust concerns

Speech acts and medical records: The ontological nexus

Despite the recent advances in information and communication technology that have increased our ability to store and circulate information, the task of ensuring that the right sorts of information gets to the right sorts of people remains. We argue that the many efforts underway to develop efficient means for sharing information across healthcare systems and organizations would benefit from a careful analysis of human action in healthcare organizations. This in turn requires that the management of information and knowledge within healthcare organizations be combined with models of resources and processes of patient care that are based on a general ontology of social interaction. The Health Level 7 (HL7) is one of several ANSI-accredited Standards Developing Organizations operating in the healthcare arena. HL7 has advanced a widely used messaging standard that enables healthcare applications to exchange clinical and administrative data in digital form. HL7 focuses on the interface requirements of the entire healthcare system and not exclusively on the requirements of one area of healthcare such as pharmacy, medical devices, imaging or insurance transactions. This has inspired the development of a powerful abstract model of patient care called the Reference Information Model (RIM). The present paper begins with an overview of the core classes of the HL7 (Version 3) RIM and a brief discussion of its “actcentered” view of healthcare. Central to this account is what is called the life cycle of events. A clinical action may progress from defined, through planned and ordered, to executed. These modalities of an action are represented as the mood of the act. We then outline the basis of an ontology of organizations, starting from the theory of speech Acts, and apply this ontology to the HL7 RIM. Special attention is given to the sorts of preconditions that must be satisfied for the successful performance of a speech act and to the sorts of entities to which speech acts give rise (e.g. obligations, claims, commitments, etc.). Finally we draw conclusions for the efficient communication and management of medical information and knowledge within and between healthcare organizations, paying special attention to the role that medical documents play in such organizations

Mayo Clinic: Multidisciplinary Teamwork, Physician-Led Governance, and Patient-Centered Culture Drive World-Class Health Care

Describes Fund-defined attributes of an ideal care delivery system, Mayo's model of multidisciplinary practice with salary-based compensation, and best practices, including a shared electronic health record and innovations to implement research quickly